August 20, 2020
COVID-19 Extended Snapshot

Perspectives on Hospital Capacity in Louisiana
Today’s PAR Snapshot takes a closer look at the critical measures of hospitalizations with the influx of COVID-19 patients. After the initial surge of coronavirus illnesses in Louisiana, hospital utilization as a percentage of hospital capacity has been relatively stable overall, increasing only modestly during the second wave. This series of charts provides an important perspective on the situation.

Currently, the use of hospital beds and intensive-care units (ICUs) – for the coronavirus and all other reasons combined – is around 70% of hospital capacity statewide, with some variations among the designated regions. About one-fourth of the available ventilators are in use. Some facilities have experienced higher levels of stress on their capacity while others have not.

Among all the hospital beds in use in Louisiana, about 12% are occupied currently by COVID patients. Among the state’s nine regions, the COVID-occupied beds range from about 7% to 16%. Hospital administrators manage the demands imposed on them by increasing capacity and redirecting procedures that are not time sensitive.
COVID hospitalizations
As cases of infection increased in June and July, more hospitalizations of COVID patients in Louisiana followed. The number of COVID patients in hospitals peaked at just over 1,500 in late July and have been in decline since then. The number of patients on ventilators has followed a similar though less severe path.
In the bar graph below, PAR reports coronavirus hospitalizations statewide per 100,000 population with a three-day average, as does the Louisiana Department of Health. This graphic demonstrates the downward trendline of COVID patients in hospitals over the past two weeks.
Hospital utilization versus capacity
Are Louisiana hospitals operating at capacity levels? As a group, they are not. This next chart measures the number of beds in use over time in Louisiana’s hospitals as a proportion of the beds available overall. The numbers of beds in use represent all patients, with and without COVID-19. The numbers of beds available is one measure of the capacity of the hospitals. The capacity numbers change over time as hospital administrators expand and contract resources. Those changes are incorporated into the calculations for the chart. At this time, the proportions of hospital beds and ICU beds in use are around 70% of total capacity. About 25% of available ventilators are currently being used.
The Capital Region is the closest to reaching capacity limits, with 85% of available ICU beds in use and ventilators at 35% of capacity. By comparison, the Bayou Region is better off with 60% of ICU beds in use and only 15% of their ventilators in use. You can see this type of chart for all nine regions of the state by visiting the COVID portal on PAR’s website.
Key considerations
Hospitals can adjust their capacity over time as they try to balance avoiding being overrun versus paying to maintain empty beds. Capacity is limited by the factors of space, equipment and personnel. Hospitals initially increased their space and equipment capacity, such as procuring ventilators and retrofitting rooms for negative pressure. Although ventilators were in short supply early on, additional machines along with evolving treatment practices have reduced the scarcity and need for them. 

But currently the biggest limit on capacity is personnel. This issue is handled through a variety of ways. Staff can be asked to work more overtime hours. Personnel can be shifted from other units. Experienced nurses can be trained to cover intensive care. ICU beds are particularly personnel-intensive as they often require a 1:1 or 1:2 ratio of nurses to patients.

Hospital administrators also manage utilization and capacity by postponing procedures. Initially the Louisiana Department of Health suspended all elective procedures, which was later clarified to cover all procedures that were not time sensitive. Emergencies, trauma and other time-sensitive cases would still be handled. Currently the hospitals are self-governed and tend to manage operations and scheduling in plans of two-week increments. It is also important to remember that these charts are state and regional capacity numbers. Different hospitals in the same region will face different pressures based on their individual resources and specializations. Hospitals that are more COVID-intensive might be closer to reaching their maximum capacity than these general charts would indicate. 

How does COVID-19 interact with capacity?
The hospital utilization ratio has been remarkably stable with fluctuations happening within narrow bounds. Hospitals were indeed affected by the July wave of COVID cases that hit the state. An increase of COVID beds followed that wave. However, the hospitalizations were not as high as the volume of new cases might suggest. This is probably due in part to the increase in testing that detected more cases but perhaps a higher proportion of less dangerous incidents. Some of the difference also could be better treatments as well as more cases among younger and less vulnerable citizens.

The proportion of COVID patients
Of all the patients in Louisiana hospitals, how many are suffering from the coronavirus? In mid-June, 6% of all patients in Louisiana hospitals had COVID. That number rose to 16% by late July. Fortunately, this number has been declining in recent days which frees up space for hospitals to treat more non-COVID patients. Currently statewide, about 12% of all Louisiana hospital patients are in for COVID.
This measure can vary by region. Based on figures for this week, about 16% of the occupied hospital beds in the Lake Charles Region are used by COVID-positive patients. In the New Orleans Region, which took the initial brunt of the pandemic, only 7% of occupied hospital beds have coronavirus patients. The New Orleans area has more beds than other regions, so there is more room for non-COVID patients. This, combined with relatively fewer per capita cases, would tend to drive down the percentage of COVID patients in Orleans regional hospitals.
PAR is presenting this information to help put into perspective the overall circumstances that the state and its hospitals are facing. Aside from the need to prevent sickness and death, public policy and citizen safety practices to mitigate COVID are also aimed at ensuring that the state’s medical system is not overwhelmed. An overtaxed system could seriously inflate the health care problems for COVID and non-COVID patients. In fact, these charts cannot tell the consequences of those who have gone without hospital care who might otherwise have done so in normal times. Even at less than capacity operations, hospitals might face significant challenges, especially considering the multiple stresses that COVID places upon the attending medical professionals.

The figures indicate that Louisiana hospitals overall, and in most regions, are coping with the pandemic and managing patient care and their operations in a stable manner. The proportion of COVID cases among all hospital patients might be less than many would have expected. This is likely a function of the safety practices of the public as well as the hospitals’ own management, who have navigated the latest rocky passage with their ships intact.  
Wednesday, August 19 Data
778 New Cases | 37 Deaths
All regions continue to decrease.

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Public Affairs Research Council of Louisiana